neuro Flashcards

Question

Dementia: define | and aetiology?

Answer 1

A set of symptoms that may include memory loss and difficulties with thinking, problem solving or language. There is a progressive decline in cognitive function. 1. Alzheimer's disease (65%). 2. Fronto-temporal. 3. Vascular. 4. Lewy bodies. 5. Vitamin deficiency e.g. B12.

Answer 2

PRIMARY CARE - **History (of symptoms) - assess cognitive functions by asking various questions** - **Mini Mental State Examination (MMSE)** commonly used to screen for cognitive function: - **Six-item Cognitive Impairment Test (6CIT) - Blood tests:- To look at the vitamin levels that may suggest a reversible cause e.g. dementia due to B12 deficiency. SECONDARY CARE - **imaging - eg CT or MRI** - for VASCULAR DEMENTIA - showing multiple cortical or subcortical infarcts or atrophy of cortex - MRI - to see extent of atrophy - **Amyloid and tau histopathology.** - **PET scans and functional MRI.**

Answer 3

No specific therapy Medication: • Acetylcholinesterase inhibitor in Alzheimer’s to increase ACh e.g. ORAL DONEPEZIL or ORAL RIVASTIGMINE • Blood pressure control to reduce further vascular damage, particularly in vascular dementia such as ACE-inhibitors e.g. RAMIPRIL

Answer 4

Alzheimer’s disease (AD) is the **COMMONEST CAUSE of dementia**, but not all dementias is due to AD **Degeneration** of the **cerebral cortex,** with **cortical atrophy** Accumulation of **beta-amyloid peptide,** a degradation product of amyloid precursor protein, results in progressive neuronal damage, neurofibrillary tangles, increases in the number of amyloid plaques and the loss of ACh (neurotransmitter) amyloid precursor protein (APP) gets chopped up by beta-secretase → **beta amyloid PROTEIN** its chemically sticky → so forms **beta amyloid placqes** can get between neurons **neurofibrillary tangles** neurons w tangles and plaques can’t signal as well and end up undergoing **apoptosis**

Answer 5

Insidious onset with steady progression over years Short-term memory loss Decline in language impaired ability to carry out skilled motor tasks long-term memory loss Around 25% of all patients with AD will develop PARKINSON’S!!

Answer 6

Specific degeneration/atrophy of the frontal and temporal lobes of the brain 1. **Behaviour variants: personality and behavioural change.** **2. Language variants.** 3. Often there is **overlap with MND.**

Answer 7

Motor neurone disease.

Answer 8

- 3rd most common cause of dementia - **Deposition** of **abnormal protein** within neurons in the **brain stem and neocortex** ASSOCIATED WITH PARKINSONS!!!! not fully understood - alpha-synuclein → gets misfolded → aggregates to form **lewy bodies inside neurones** → as disease progresses, more and more neurons get deposits of lewy bodies and die!!!

Answer 9

**early symptoms:** - mostly cognitive like **difficulty w focusing and attention, poor memory, visual hallucinations, disorganised speech, depression** - SIMILAR TO AD **later symptoms:** - more motor symptoms like **resting tremors, stiff and slow movements, reduced facial expression**s - similar to PARKINSON’S - Prominent or persistent **memory loss** may not occur in the early stages - **have difficulty learning new info**

Answer 10

motor symptoms: drugs used to treat parkinson’s → **LEVODOPA** (dopamine analogue) cognitive symptoms: - drugs used to treat AD → **DONEPEZIL**

Answer 11

Primary: • No underlying cause relevant to the headache • Examples include; migraine (20% of population), cluster and tension headache (affect 99% in lifetime) Secondary baso red flag headaches • There is an underlying cause • These are the ones where you need to identify the underlying cause e.g. giant cell arteritis which can cause headache Red flags for secondary headache - **Thunderclap** headache (think subarachnoid haemorrhage!) - Seizure and **new headache** - Suspected **meningitis** - Suspected **encephalitis** papilloedema

Answer 12

**CHOCOLATE**: - Chocolate - Hangovers - Orgasms - Cheese - Oral contraceptives - Lie-ins - Alcohol - Tumult - loud noise - Exercise ALSO - - Brain chemical imbalance may be cause - May be caused by changes in the brainstem and its interactions with the trigeminal nerve

Answer 13

- Migraine without aura: • **Attacks last 4-72 hours** • Two of the following: - **Unilateral (70%) and upper half!!** - **gradual onset** - **crescendo pattern** - increasing in intensity!!! - **moderate-severe intensity** pain in head - During headache at least one of:/Associated symptoms: - **Nausea and/or vomiting** during headache - **Photophobia (light sensitive)** and **phonophobia (sound sensitive)** during headache (these are not attributable to another disorder) - **aura** (feeling that something is about to happen)

Answer 14

- Reduce triggers e.g. avoid dietary factors - **simple analgesia eg paracetomol** - Acute: - DO NOT OFFER ERGOTS e.g.ergotamine or OPIODS - **Triptans e.g. SUMATRIPTAN**: - Selectively stimulate 5-hydroxytryptamine receptors in brain - Contra-indicated in ischaemic heart disease, coronary spasm and uncontrolled high BP - S/E; arrhythmias or angina +/- MI - ***NSAIDs** e.g. **KETOPROFEN, NAPROXEN* or ASPIRIN** - good since *less chance of developing medication overuse headache* - Avoid paracetamol or ibuprofen - **+/- anti-emetic e.g. PROCHLORPERAZINE** - and **HYDRATION**

Answer 15

MOST CHRONIC DAILY & RECURRENT HEADACHES are tension headaches

Answer 16

Bilateral - **Tight band-like sensation around forehead/eyes** - which **waxes and wanes** Headaches can last from 30 mins to 7 days usually WITHOUT associated symptoms - Without vomiting or sensitivity to head movement, no aura

Answer 17

SIMPLE ANALGESICS • ASPIRIN • PARCETAMOL

Answer 18

**Most disabling of the primary headache disorders** associated w **trigeminal neuralgia**

Answer 19

- **unilateral** normally - **around eye/orbit area** - Abrupt onset - Rapid onset of **CONTINUOUS, EXPLOSIVE AND EXCRUCIATING pain AROUND ONE EYE, TEMPLE or FOREHEAD** - Ipsilateral cranial autonomic features: • Eye may become watery and bloodshot with lid swelling, **lacrimation**, • Facial flushing • Rhinorrhea (blocked nose) • **Miosis (excessive pupil constriction) +/- ptosis (drooping or falling of upper eyelid**) - seen in 20% of attacks - **nasal discharge**

Answer 20

- **Analgesics are unhelpful!!!!** - 100% 15L **OXYGEN** for 15mins via non-rebreathable mask (not if COPD) - **Triptan (selective serotonin (5HT) agonist)** e.g. SC **SUMATRIPTAN**: - Triptans are serotonin receptor agonists - this reduces vascular inflammation - BUT TRIPTANS ARE CONTRAINDICATED IN PT W CAD or CVS or cerebrovascular disease

Answer 21

1. Headache present for **>15 days/month.** 2. Regular use for **>3 months of >1 symptomatic treatment drugs.** 3. Headache has **developed or markedly worsened during drug use.**

Answer 22

MEDICAL EMERGENCY compression, trauma or damage to the peripheral nerves protruding from the bottom of the spinal cord - cauda equina = formed by the nerve roots caudal (distal) to the level of the termination of the spinal cord at L1/L2 Cauda Equina functions: carries motor innervation for: - **genitals**! - internal and external **ANAL** sphincters - detrusor vesicae - muscle in bladder that contract during **urination** - and muscles of leg - knee and ankle reflexes - skin sensations of legs and pelvis

Answer 23

Herniation of lumbar disc - most common cause of CES - MOST COMMONLY at L4/5 and L5/S1 -- Trauma - Poor posture - Physical Activity - strong rotational movement Tumours/Metastases Infection Trauma Spinal Stenosis Spondylolisthesis

Answer 24

Cauda equina presents with lower motor neuron signs (reduced tone and reduced reflexes). The nerves being compressed are lower motor neurons that have already exited the spinal cord. - **Bilateral sciatica** - **sciatic pain** - sharp pain going down back and legs - **(pain radiates down the leg to the foot).** - **Saddle anaesthesia** - loss of sensation in saddle area - includes buttocks, inner surface of thigh and perineum - **Bladder/bowel dysfunction** - • ***Faecal incontinence*** - • ***Loss of sensation*** in the ***bladder*** and ***rectum*** (not knowing when they are full) - • ***Urinary retention*** or ***incontinence*** - due to decreased tone of anal sphincters and muscle wall of bladder - **Erectile dysfunction/decreased sexual function** - **Variable leg weakness that is FLACCID & AREFLEXIC (LMN signs) **

Answer 25

sually **CLINICAL** - based on pattern of sensory and motor nerve findings - **MRI** to localise lesion - TO CONFIRM !!!!!!!!!!!!!!!!!!!! - OR **CT scan** to confirm

Answer 26

**Refer to neurosurgeon ASAP to RELIEVE PRESSURE or risk irreversible paralysis/sensory loss/incontinence!!!!:** - **SURGICAL decompression** - within 48 hrs - symptoms will appear suddenly if due to disc herniation, trauma, tumours, or abscess - **antibiotics**- to treat abscesses BUT IF DEGENERATIVE DISEASE (symptoms will appear more gradually): - **ANTI-INFLAMMTORY meds and corticosteroids**

Answer 27

- **Vertebral body neoplasms** - MOST COMMON CAUSE OF ACUTE COMPRESSION:!!! - **Secondary malignancy commonly from lung, breast, prostate, myeloma, lymphoma** - **Disc herniation:** - When centre of disc (nucleus pulposus) has moved out through the annulus (outer part of disc) resulting in pressure on nerve root and pain - **Disc prolapse:** - When nucleus pulposus moves and presses against the annulus but it doesn't escape outside the annulus Rarer: • Infection e.g. epidural abscess • Haematoma e.g. warfarin Primary spinal cord tumour e.g. glioma, neurofibroma

Answer 28

When the spinal cord is being compressed higher up by metastatic spinal cord compression, upper motor neuron signs (increased tone, brisk reflexes and upping plantar responses) will be seen. - **back pain** **weeks before any neurological symptoms appear** - first symptom - progressively worsening - changes w position - **weakness )motor weakness)** - abnormal gait - upper or lower extremity dysfunction - **sensory changes** - less common - clinically useful tho Bladder (and anal) sphincter involvement is late and manifests as hesitancy, frequency and later as painless retention

Answer 29

DO NOT DELAY IMAGING, AT ANY COST!!!! - since irreversible paraplegia may follow if the cord is NOT DECOMPRESSED!!!! MRI:!!!!! • GOLD STANDARD • Identifies the cause and site of cord compression AND MRI BRAIN if mets suspected CT scan with contrast is useful when time-limited but may be limited w in trauma - combine SPINAL XRAY W CT ----- Biopsy/surgical exploration may be required to identify the nature of any mass Screening blood tests: FBC, ESR, B12, U&E’s, syphilis serology, LFT, PSA

Answer 30

If malignancy then give IV DEXAMETHASONE glucocorticoid (reduces inflammation/oedema around malignancy and improves outcome) and consider more specific therapy e.g. radiotherapy or chemotherapy(most lesions are chemo-resistant) or surgery - **Epidural abscess** must be **surgically decompressed and antibiotics given** - **Refer to neurosurgeons!!:!!!** • Epidural steroid injection - effective for leg pain • Surgical decompression of cord: - LAMINECTOMY - removal of the lamina/spongy tissue between discs to relieve pressure and thus symptoms - MICRODISCECTOMY - removal of herniated tissue from disc

Answer 31

below = 3 gliomas: - astrocytomas - (glioblastoma multiforme is the most common) ----> sooo glioblastomas highly malignant = Grade IV - Oligodendroglioma - relatively rare - genetic defects in chromosomes in 1 and 19 - - typically form in frontal lobes - relatively slow-growing and can become malignant - **Grade II-Grade III** - Ependymoma THEN MENINGIOMA - arise from the arachnoid mater and may grow to a large size, usually over years - pushing into the brain - graded I-III - relatively slow growing - They are usually benign, however they take up space and this mass effect can lead to raised intracranial pressure and neurological symptoms. - **PITUITARY ADENOMA** - formed in pituitary gland by hormone-secreting cells of ANTERIOR pituitary - typically **benign -** no WHO class HAEMANGIOBLASTOMA - derived from cells w blood vessel origins - usually found in cerebellum - slow-growing - typically **Grade 1**

Answer 32

1. Grade 1: benign paediatric tumour. 2. Grade 2: pre-malignant tumour. 3. Grade 3: 'anaplastic astrocytoma' - cancer. 4. Grade 4: glioblastoma multiforme (GBM).

Answer 33

Symptoms of raised ICP: - Progressive headache: - ----worse on waking - cluster headache - Pain is increased by coughing, straining and bending forwards - +/- Vomiting and nausea - CARDINAL SIGN IS PAPILLOEDEMA - key finding on fundoscopy - Swelling of the optic disc due to obstruction of venous return from the retina due to the raised ICP bc sheath around optic nerve is connected w the subarachnoid space seizures (particularly focal) - **unilateral ptosis** - **altered mental status** - **3rd and 6th nerve palsies** Progressive neurological deficit: - Significantly altered consciousness, memory, confusion.

Answer 34

LUMBAR PUNCTURE IS CONTRAINDICATED when there is any possibility of a mass lesion since withdrawing CSF may PROVOKE IMMEDIATE CONING - that is herniation of the brain through the foramen magnum resulting in BRAINSTEM COMPRESSION as it passes through foramen magnum and POTENTIAL DEATH - CT & MRI: • MRI is superior for posterior fossa lesions • Determine the size and location of lesions • High grade tumours have irregular edges and high growth rate - Blood tests e.g. FBC, U & Es, LFT’s, B12 etc. - Biopsy: • Via skull burr-hole • To determine cancer grade and confirm!!

Answer 35

**Commonest neoplasms to metastasise to CNS in order:** - Non small cell LUNG - MOST COMMON - Small cell LUNG - Breast - Renal cell - Melanoma - GI

Answer 36

Epilepsy is an umbrella term for a condition where there is a tendency to have seizures. The recurrent tendency to spontaneous, intermittent, abnormal electrical activity in part of the brain, manifesting in seizures A CHRONIC DISORDER i.e. need at least 2 seizures to be defined as epileptic

Answer 37

when both hemispheres are affected (**sometimes will start out as partial seizure → then will quickly develop into generalised seizure** → = **SECONDARY GENERALISED SEIZURES**) - Tonic Seizures - where **muscles** become **stiff and flexed - tense**can cause pt to fall - often BACKWARDS - Atonic Seizures - where **muscles suddenly relax and become floppy** - can cause pt to fall - often BACKWARDS - Clonic Seizures - w **violent muscle contractions** aka **convulsions - muscle JERKING** - Generalised Tonic-Clonic Seizures → most common generalised seizures - **loss of consciousness** - and ***tonic*** (muscle tensing) **THEN** → ***clonic*** (muscle jerking) movements. - Myoclonic Seizures - present as **sudden brief muscle contractions,** like a sudden “jump” - **short muscle twitches** - sometimes many in a short amount of time aka petit mal - typically happen in **children** - patient becomes blank, stares into space and then abruptly returns to normal - **lose consciousness then quickly regain consciousness**

Answer 38

these are seizures where only one hemisphere or one part of the brain or one lobe is affected - **Simple partial seizure:** - **when they remain conscious** - **Not affecting consciousness or memory** - **Awareness is unimpaired - usually knows something is happening -** - **Complex partial seizure:** - **impaired consciousness** - **Affecting awareness or memory before, during or immediately after the seizure**

Answer 39

Focal seizures start in the ***temporal lobes***. They affect **hearing, speech, memory and emotions.** Can present: - **Hallucinations** - **Memory flashbacks** - **Déjà vu** - **Doing strange things on autopilot**

Answer 40

- **Generalised tonic-clonic seizures (grand-mal):** - First line: ***sodium valproate** S/E: weight gain, hair loss, liver failure NOT IN PREGNANCY WOMEN - teratogenic - Second line: ***lamotrigine*** or ***carbamazepine*** - **Focal Seizures* - First line: ***carbamazepine*** or ***lamotrigine- Second line: ***sodium valproate*** or ***levetiracetam*** - **Absence seizure (petit mal):** - First line: ***sodium valproate*** or ***ethosuximide* S/E: rashes, night terrors - **Atonic Seizures:** - First line: ***sodium valproate*** - Second line: ***lamotrigine*** - **Myoclonic Seizures:** - First line: ***sodium valproate*** - Other options: ***lamotrigine***, ***levetiracetam*** or ***topiramate***

Answer 41

Status epilepticus is an important condition you need to be aware of and how to treat. It is **a medical emergency.** Causes could be: Abruptly stopping anti epileptic treatment; Alcohol abuse; Poor compliance to therapy It is defined as a seizure lasting **more than 5 minutes** or **2 or more seizures without regaining consciousness** in the interim. take an ABCDE approach): - Secure the airway - Give **high-concentration oxygen** ...... IV lorazepam, repeated after 10 minutes if the seizure continues If the seizures persist the final step is an infusion of IV phenobarbital or phenytoin. At this point intubation and ventilation to secure the airway needs to be considered, along with transfer to the intensive care unit if appropriate. **Medical options in the community:** - Buccal midazolam - **Rectal diazepam** (BENZODIAZAPINE) - enhance effect of inhibitory neurotransmitter GABA

Answer 42

- **Prodrome**: - Lasting hours or days may rarely precede the seizure - Not part of the seizure, results in change of mood or behaviour - **Aura**: - Part of seizure where the **patient is aware and may precede its other manifestations** - **Strange feeling in the gut, deja vu or strange smells or flashing lights** - Implies a partial (focal) seizure often but not necessarily from the temporal lobe - **Post-ictally (after seizure):** - Headache, **post-ictal confusion**, myalgia and a sore tongue - Temporary weakness after a focal seizure in motor cortex - Todd’s palsy paralysis (usually limited to one side of body) - **TODD’S PARALYSIS** - lasts average -15hrs - subsides completely after 2 days - due to maybe temporary and severe suppression of area of brain

Answer 43

- More common in **FEMALES than males** - Presentation is typically between **20-40yrs** More common the further from the equator you go - rare in tropical countries

Answer 44

Diagnosis requires **TWO or more attacks affecting DIFFERENT PARTS of CNS**; that is **2 CNS lesions disseminated in time and space** i.e. cannot diagnose MS after one potential relapse - Usually presents in **young adults 20-40 yrs** - **worsens over weeks and can linger for mths wo treatment** - **CHARCOT’S NEUROLOGIC TRIAD** dysarthria nystagmus intention tremors - **Spacticity** - Spasticity & weakness - can result in **stiffness/tightness of muscles** t*hat can interfere with normal movement, speech and gait* - Symptoms can be exacerbated by - - **Heat** - typically a warm shower. - Symptoms can be **relieved by cool temperatures.** - **Visual problems eg blurred vision** - Unilateral optic neuritis: • Pain in one eye on eye movement • Reduced central vision - **Abnormal sensations** - e.g. numbness or tingling in the limbs or paraesthesias - **weakness eg** - Leg weakness - plaques in autonomic systems - **Bladder dysfunction** e.g. urgency, frequency and INCONTINENCE - **Sexual dysfunction**

Answer 45

Diagnosis requires TWO or more attacks affecting DIFFERENT PARTS of CNS; that is 2 CNS lesions disseminated in time and space i.e. cannot diagnose MS after one potential relapse MRI scan brain & cord: • DIAGNOSTIC - **Lumbar puncture:** • CSF examination shows oligoclonal IgG bands in over 90% cases - but these are not specific to MS • **CSF - may be high levels of ab!!! -** cell count may be raised - ELECTROPHORESIS OF CSF might show **oligoclonal IgG bands* - Electrophysiology (**visual evoked potential studies):** measures nervous system response to visual stimuli

Answer 46

- non-pharmacological treatment for MS: 1. Psychological therapies and counselling. 2. Speech therapists. 3. Physiotherapy and occupational therapy. Acute relapse: short course steroids like • IV METHYLPREDNISOLONE for less than 3 days can help shorten acute relapse - use steroid sparingly and aim to use less than twice a year - **Relapsing Remitting MS (RRMS)** - **IMMUNOMODULATORS** - like SC **INTERFERON 1B or 1A** MONOCLONAL ANTIBODIES EG IV ALEMTUZUMAB or IV NATALIZUMAB!!!! ``` Symptomatic treatment FOR MORE PROGRESSIVE MS: eg for spasticity - **muscle relaxants** - **Physiotherapy** - **BACLOFEN** TIZANIDINE BOTOX INJECTION ``` - Incontinence - - anti-cholinergic alpha-blocker drugs e.g. **DOXAZOSIN** Aggressive treatment is STEM CELL TRANSPLANT

Answer 47

- **Amyotrophic lateral sclerosis (ALS)** is the most common and well-known specific *motor neurone disease*. Stephen Hawking had amyotrophic lateral sclerosis. - ***Progressive bulbar palsy*** is the second most common form of ***motor neurone disease***. It affects primarily the muscles of talking and swallowing. - Other types of motor neurone disease to be aware of are ***progressive muscular atrophy*** and ***primary lateral sclerosis***.

Answer 48

a type of MNd Lower cranial nerves (CN 9,10,11,12) and nuclei initially ONLY affected **LMN only** Dysarthria, dysphagia, nasal regurgitation of fluids and choking are the presenting symptoms 3. Wasting and fascitulations of the tongue.

Answer 49

- **insidious**, **progressive weakness of the muscles throughout the body affecting the limbs, trunk, face and speech.** - The weakness is often first noticed in the upper limbs. Signs of ***lower motor neurone disease***: - Muscle wasting - Reduced tone - Fasciculations (twitches in the muscles) - Reduced reflexes Signs of ***upper motor neurone disease***: - Increased tone or spasticity - Brisk reflexes - Upgoing plantar responses

Answer 50

- **Riluzole** - *inhibits glutamate release and slows disease progression.* - V**entilatory support.** - Feeding by a **PEG.**

Answer 51

1. Motor cortex lesions. 2. Internal capsule. 3. Brainstem. 4. Spinal cord.

Answer 52

signs are **CONTRALATERAL to lesion** - Indicate that the lesion is above the anterior horn cell i.e. in the spinal cord, brainstem and motor cortex - **HYPERREFLEXIA** - Increased reflexes, they are brisk - **Increased muscle tone - SPASTICITY:** - Velocity dependent and non-uniform i.e. the faster you move the patients muscle, the greater the resistance, until it finally gives way in a clasp-knife manner - little or no muscle atrophy - **Weakness**: - Flexors are generally weaker than extensors in legs and reverse in arms - **POSITIVE babinski’s sign**

Answer 53

signs are **IPSILATERAL** to lesion Indicate that the lesion is either in the anterior horn cell or distal to the anterior horn cell i.e. in anterior horn cell, plexus or peripheral nerve - **Decreased muscle tone** - **muscle WASTING (atrophy)** +/- **FASCICULATIONS** (spontaneous involuntary muscle twitching/contraction) - **Weakness** that corresponds to those muscles supplied by the involved cord segment, nerve root, part of plexus or peripheral nerve - **Reflexes are reduced or absent** - inc plantatr reflex / negative babinski’s sign!! - diminished or absent tendon reflexes

Answer 54

**Autoimmune** disease against (skeletal muscles**) NICOTINIC ACETYLCHOLINE RECEPTORS (AChR) in the neuromuscular junction** baso NMJ DAMAGE motor neurone **release ACh** which **binds to nicotinic ACh receptors** on muscle cell membranes → muscle contraction **type II hypersensitivity reaction-** cytotoxic injury and mediated by autoantibodies baso body’s b cells make ab **(anti-AChR antibodies)** which bind to nicotinic recpetors on muscle cell membranes

Answer 55

- **Increasing muscular fatigue AND WEAKNESS** - might wake up feeling fine but end of day feel v weak - perhaps weakness w repetitive movements eg chopping veg ``` - **Muscle groups affected in order:** • **Extra-ocular** • Bulbar - swallowing & chewing • Face • Neck • Trunk ``` - affects **extra-ocular muscles** - controls movement of eye and eyelid - Look for **ptosis** (drooping of upper eyelid), **diplopia (double vision)** and myasthenic snarl on smiling

Answer 56

Serum anti-AChR: SERUM ANTI-ACh receptor antibodies • Raised in 90% • If negative then look for MuSK (muscle specific tyrosine kinase) antibodies (anti-MuSK) Antibodies against tyrosine kinase - anti-MuSK antibodies ,y be present .

Answer 57

Anti-cholinesterase - ACETYLCHOLINISTERASE INHIBITORS - baso stops the breakdown of ACh and increases concen of ACh - so more ACh remains in neuromuscular junction e.g. ORAL PYRIDOSTIGMINE OR NEOSTIGIMINE

Answer 58

Syncope is the **loss of consciousness** due to **hypoperfusion to brain** Insufficient blood or oxygen supply to the brain causes paroxysmal changes in behaviour, sensation and cognitive processes.

Answer 59

Prolonged upright position e.g. long time standing, sweat prior to loss of consciousness, nausea, pre-syncopal symptoms

Answer 60

1. Situational. 2. 5-30s in duration. 3. Sweating 1. Nausea. 2. Pallor. 3. Dehydration.

Answer 61

neuralgia (facial pain) - a painful cranial neuropathy Compression of the trigeminal nerve results in demyelination and excitation of the nerve resulting in erratic pain signalling - In most cases is due to **compression of the trigeminal nerve by a loop of vein or artery** - Can be due to ***local pathology such as aneurysms, meningeal inflammation, tumours*** Trigeminal nerve **(CN5**) has both **motor and sensory functions** and enters the brainstem at the level of the pons

Answer 62

- **ALMOST ALWAYS UNILATERAL** - A**t least 3 attacks of unilateral facial pain - RECURRENT EPISODES** freq increases over time - **Facial pain** MANDIBULAR zone affected most - **few seconds** - **Severe intensity INTENSE AND EXCRICIATING!!** • **Electric shock like, shooting, stabbing** 1. Unilateral face pain. 2. Pain commonly in V3 distributon. 3. Very severe. 4. Electric shock like/shooting/sharp. can be triggered by: 1. Washing your face.2. Eating.3. Shaving.4. Talking.

Answer 63

- **Clinical diagnosis based on criteria above and based on history** - **MRI to exclude secondary causes or other pathologies**

Answer 64

typical analgesics and opioids DO NOT WORK - **Anticonvulsant** e.g. **ORAL CARBAMAZEPINE** suppresses attacks in most patients or **oxcarbazepine** 2nd line: - **baclofen or lamotrigine** **severe cases: surgery**

Answer 65

***Sciatica*** refers to the symptoms associated with irritation of the ***sciatic nerve*** Sciatica is **pain, numbness and a tingling sensation** that radiates from **lower back and travels down one of the legs to the foot and toes** The main causes of sciatica are lumbosacral nerve root compression by: - ***Herniated disc*** - ***Spondylolisthesis*** (anterior displacement of a vertebra out of line with the one below) - ***Spinal stenosis***

Answer 66

- **unilateral** pain **from the buttock radiating down the back of the thigh to below the knee or feet.** - **“electric” or “shooting” pain** - ***paraesthesia*** (pins and needles), - ***numbness*** and ***motor weakness*** - ***Reflexes*** may be affected depending on the affected nerve root.

Answer 67

The sciatic stretch test can be used to help diagnose sciatica. - Treatment for sciatica WO NEUROLOGICAL SIGNS: - **Conservative management** e.g. **physio and NSAIDs.**- Self-management - Education - Reassurance- Analgesia - Staying active and continuing to mobilise as tolerated They suggest considering a neuropathic medication if symptoms are persisting or worsening at follow up, but **not** gabapentin or pregabalin, leaving at the main choices of: - ***Amitriptyline!!!*** - ***Duloxetine!!!*** Specialist management options for chronic sciatica include: - ***Epidural corticosteroid injections*** - ***Local anaesthetic injections*** - ***Radiofrequency denervation*** - ***Spinal decompression***

Answer 68

CAUDA EQUINA SYNDROME

Answer 69

- CN3 Palsy CN 3 (**Oculomotor**) palsy: - **Ptosis** - dropping eyelids - Fixed dilated pupil - loss of PARASYMPATHETIC outflow from EDINGER WESTPHAL NUCLEUS which supply pupillary sphincter and ciliary bodies - lens accomadation - Eye down and out - CN4 Palsy CN 4 (**Trochlear**) palsy: - Innervate superior oblique muscle and results in a **head tilt** to correct the extortion that results in diplopia on looking down e.g. walking downstairs - CN6 Palsy Innervate the lateral rectus muscle thus **eyes will be adducted** - CN 3,4,6 palsy: - Non-functioning eye - CN 5 (Trigeminal) palsy: - Jaw deviates to side of lesion - Loss of corneal reflex - CN 7 (Facial) palsy: Facial droop and weakness - CN 8 (Vestibulocochlear) palsy: - Hearing impairment - Vertigo and lack of balance - CN 9 (Glossopharyngeal) & CN 10 (Vagus) palsy: - Gag reflex issues - Swallowing issues - Vocal issues

neuro Flashcards

(93 cards)